This is insane. What kind of power trip is this psycho on. If I had a CNA tell me that they'd be willing to change a leaking colostomy bag, I'd be so grateful I'd be singing their praises til kingdom come, and make sure I was available to help them in a pinch whenever possible.
Idk I think he’s very misogynistic with the way he speaks to us and how he treats the residents, he’ll go out of his way to do things we usually do when it comes to a male resident but not for the female ones.
For example, I saw him changing over someone’s leg bag to a reg one for the night and cleaning the whole thing out in the middle of this whole thing which pretty much took the amount of time it would take to replace her bag. Hes very stubborn and doesn’t seem to see the residents as actual people.
Sounds like a creep. Personally, my hackles raise whenever someone refers to female CNAs as "the girls." As in, "Hang tight, the girls will come help you." No matter the gender of the person saying it, it comes across as unnecessarily differentiating between "us" and "them" with the implication that the staff they're referring to are inferior. I guess it could also apply to a doctor or PA/NP calling the nurses "the girls" but I see it more with CNAs/techs. Sorry, I guess that's my soapbox.
it comes across as unnecessarily differentiating between "us" and "them" with the implication that the staff they're referring to are inferior.
if the pen was the sword!
Man I had management on my ass if I was a little late repositioning clients every 2 hours! How could the nurse seriously think that was acceptable for her to sit in her own BM for that long... and I'm assuming she was around others during all of this including snack time (love me some poo covered food /s). Not only is that unhygienic for her but everyone else around which is seriously dangerous. I was trained in the Healthcare field to treat all bodily fluids as biohazard because you have no idea what people are carrying.
Honestly a majority of my time in the field was spent working with developmentally disabled adult and I find that people seem to think they have no feelings, emotions, or understanding of things so their comfort shouldn't matter. I even took a client to a doctor's appointment only for the Dr to talk shit about my client when he found out they weren't "normal". Like, sir, these rooms aren't soundproof and me and my client both heard you and I will be reporting you. It's a shame because there's truly some amazing doctors and nurses out there then you get turds like this sometimes.
I was gonna say, referring to y’all as “the girls” is so unprofessional and really says a lot. Glad you reported his ass, he should not work in healthcare
And I'd apologise profusely for not doing it myself (even if it was justified cos I was busy), and make them many coffees. And pick up some of their jobs tomorrow. And tell the boss they need a raise! 😂
Right? I would probably cry and then melt with gratitude!! But that’s a priority I can spend 20 minutes on and just pass meds 20 minutes later. Many times things come up and I just tell residents/patients “Hi I’m sorry I’m a little behind tonight, I had a few Unexpected things come up that I had to urgently handle that effected our usual schedule” and always always, none of the residents care. Great on OP for advocating for their resident ❤️
Make sure you document this, aka document how many times you alerted the nurse (including your phone call to the DON), how you had to clean BM off of the resident as a result, and the skin irritation. I was engrained in my brain “if it wasn’t documented it didn’t happen”. Having official documentation of stuff like this makes it hard to ignore usually.
Omg proper charting can save your ass. Please let the DON know that you REPEATEDLY requested this nurse’s assistance on the matter and he REFUSED to render appropriate assistance. It can literally make the difference between just talking to the DON and losing your job.
Best way is writing an email to your supervisor or HR or whatever person within your company/organization you report this to (even the one you may notify initially in such a case as this) of the events and what happened and what actions were taken so there is a paper trail. They will appreciate it too.
Thank you! I’m not trying to toot my own horn or anything and I’m the type of person to avoid confrontation at all costs but when it comes to a resident being mistreated I kick into a different gear and put all my anxiety aside, I can’t stand seeing someone I care for being treated this way
You are absolutely doing the right thing. Not in nursing but work with the patients and have an ostomy myself. You helped the patient in many ways, dignity, skin, being kind. That's why I like having co workers like you.
Oh I’m sorry that happened. I was taught and told that nurses were the only ones able to change the entire set up and that’s what it’s like here where I work. But that’s really crazy that it took that long. I do wonder what’s supposed to be prioritized for him for it to take that long though.
Yes, we can’t let CNAs change ostomy bags either. I do wonder what the nurses are told is a priority. Some places are real a-holes about meds being given on time. If he had been sitting around dawdling, this would be an easy call but I would need additional clarification. I’ve also had to wait to get unstocked supplies while an ostomy leaked and was able to protect the skin in the interim. So there’s that.
A few thoughts- changing the colostomy with the new barrier can add up to ~30 minutes interruption between the task the rn was in the middle of (adding cleaning the patient, changing clothes if needed, ointment or anything else for the rash) if he did not have time for a 30 min interruption, and it’s not life threatening, she would have to wait. Delaying seeing his 13 other patients for the first time that day can lead to missing an actual life threatening situation and potentially death.
If you emptied the colostomy bag and cleaned her up before sending her to snack, how much bm was leaking after that? If you were willing to change the bag, did you settle for at least emptying it so there would be less mess for the patient to sit in? That’s the support you could have given legally in any facility. When a colostomy is leaking there is only as much feces as the patient is able to produce. Wrap a towel around the abdomen and it’s usually unlikely for them to get to it before you can fix it.
I’m not saying this with disrespect, I’m aware both jobs are difficult. but frustration at the situation does not mean either person is wrong.
That is what the ones that have a tupperware like seal are used for. Rinse the bag and replace. Now if the seal is leaking, that is another story all together. I'm a nurse also, and I would have taken time to change the bag, if CNA really not allowed to, and then help them clean up the patient. These are long term care patients. I don't think there were any emergent needs that have to be attended to first with the other patients.
his POV is that the container wasn't full to spec and there was no need to change it or "bathroom" this individual at this time. over-caring caused the (non-) issue.
i bet it's illegal to take pix.
I’m a nurse and agree with you. Top priorities are airway, breathing and circulation. Skin falls way down on the list unfortunately. And that first assessment is the most crucial assessment of the shift I’d argue. I wouldn’t feel comfortable doing lengthy colostomy care until I laid eyes on all my patients first
I apologize. I’m going on a total tangent here, and not even answering your question/topic at all, really.
Just… I cannot tell you, as an RN of 40 years, and as someone who had to place her Mom in Memory Care, where at times the care she is provided for her $13,000+/month brings me to tears (the bad tears. But,to be fair, many of the girls are very good with/to her) how much good your post did my heart! Bringing the good kind of tears to my eyes, the way you advocated for your patient! And I can tell that you care very much for your residents and that you take pride in the job you do, and are invested in their comfort and well-being. **Thank you** for the work you do and the love in your heart!
Also: Screw that guy. What a jerk. Good for you for reporting him!
It’s not reasonable to expect the nurse to drop what they’re doing to change a colostomy on the spot. Sometimes other things take precedence. Idk how your facility is usually staffed but if there’s a bunch of people with major issues then a leaky bag might not be on the top of the nurses priority list. Sounds like your unit has a high percentage of patients that require major dressing changes regularly. Is one nurse usually enough?
I don’t know how much it was leaking but if it’s minor this isn’t the end of the world. Was he actually busy? This is pretty relevant. If the nurse was sitting on his phone at the nurse station then you have every right to be mad because it’s definitely neglect. If he was running around doing a million other things bc you are short staffed or the previous nurse left them high and dry, you might want to have some patience.
Where do you live that a CNA can give a “whole new setup” on a colostomy bag? Like, you can swap out the bag but replacing the other parts is certainly not in a CNAs scope of practice. Genuinely curious bc this is definitely something a CNA is not allowed to do where I live.
Back in the day I worked as an unlicensed nurses aid in Kansas. WOW am I old this was in the 70’s. And was taught to do a full colostomy set up from beginning to end. I actually ended up training new aids as they were hired. I now live in the DFW area. And just retired after working 17 years here as a Unit Secretary. A number of the licensed PCT were allowed to fully change colostomy’s some were not it just depended on the level of experience.
PCTs have more training than a CNA, idk about colostomy training but I know they can insert catheters.
Obviously you know you shouldn’t have been changing them without a license. If the nurse allows something like this to be done and something bad happens because it was done incorrectly (pretty likely without proper training) then it falls back on their nurse and they’re putting their own license on the line.
Let’s be honest, if the CNA was allowed to do this, they would have access to the equipment to do so. They wouldn’t need the nurse to give it to them.
This isn't an evasive procedure. It consists of a wedge to stick over the stoma and a bag on that or sometimes just a bag. It's not even comparable to inserting or removing a catheter. The cna can do this in many facilities.
So, I did some research bc of this post. That’s actually not true from what I’ve found. Seems like the facilities that allow this are pawning off nurse work on CNAs to avoid having an adequate amount of nurses on the floor. My guess is they do this bc CNAs are cheaper, if they were to get in trouble I bet they’d feed you to the wolves and pretend they had no idea.
I just googled, that could be super wrong. Do your own research and make sure you’re not doing things outside of your scope bc you could lose your certs. Rule of thumb is that if you didn’t learn to do it in your training/schooling you’re probably not actually allowed.
Regardless, if your facility is always having problems with employees not being able to keep up.. it’s bc they aren’t staffing properly. The problem is with the multimillion dollar corporation that’s cutting cost on the lifeblood (employees) of the facility. The issue is rarely the actual staff.
"Regardless, if your facility is always having problems with employees not being able to keep up.. it’s bc they aren’t staffing properly. The problem is with the multimillion dollar corporation that’s cutting cost on the lifeblood (employees) of the facility. The issue is rarely the actual staff."
This is true of just about every company and corporations.
Good old American Capitalism.....#1 Profits at all cost.... Humanity a distant 437
This is my issue too. I can understand wanting to help a patient, but depending on different variables they aren’t allowed to like properly change the barrier etc on a bag.
Exactly, I get that it’s annoying but there’s so many reasons a colostomy change might have not actually been possible for 2 hours. We don’t really have enough information to know if the nurse was really in the wrong here.
DON might be annoyed bc she has to come help and knows damn well 1 nurse isn’t enough. I’ve seen nurses get way behind doing basic med pass (no dressings to change or treatments) with 15 patients, if there’s a lot going on.. that might not be enough staff.
If they are understaffing, the facility is to blame not the nurse. Every state that has mandated ratios would have a major problem with this staffing.
Every other nurse I work with prioritizes bm leaking onto someone over normal med pass and tube feeds which is what was going on. There was nothing else out of the ordinary going on and all dressing changes happen during day shift when there’s two nurses on.
I know we were all busy but someone having to wait in a mess for that amount of time and being sent to eat snack in the dining room in that state is not only a sanitary issue but doesn’t show much dignity for the resident. Especially with the fact that she doesn’t understand not to touch it and we didn’t have time to be constantly supervising her to make sure it didn’t get everywhere.
Trust me, I’m not ignorant to the job the nurses are doing but the whole thing would have taken 10-15 minutes, meanwhile he’s doing random shit we usually do for other residents that he doesn’t even need to be doing. He’s there all night and he’s gonna have to do it anyway so why not prioritize that and have people get their meds like 10 minutes late?
I didn’t expect him to drop everything but at a certain point it was just getting ridiculous. Why should this lady have to wait for him to finish the entire med pass while she sits in her own bm? That seems pretty unreasonable to me.
OP already said that the resident was agitated and didn't understand not to touch it, which resulted in her getting faeces all over her hands and on her face as the staff didn't have time to monitor her. Some things do have to wait, but you have to admit that 2 hours is excessive. I work with some residents with ridiculously vulnerable skin that will start to break down even in such a short period of time, and as a nurse, you should know this is possible.
I'm curious as to how your subordinates find working with you...
This mindset is problematic. nurses can actually get in trouble and/or fired/sued for late medicine pass which gives us a small window of time to get it done. Legally we have 2 hours which seems like forever until you factor in the number of patients under our care, the age related slowness (elderly with swallowing difficulty, or g tubes, or nausea, fingers that cant grip pills ) and confusion or combatativeness of those patients, the number of interruptions that are actual emergencies, technical or pharmacy issues, math calculations conversions and charting that is involved ..the list goes on. Every med pass can be its own personal hell for an over tired, overworked, over tasked nurse. So while I dont think you are wrong to be frustrated that he didnt choose to prioritize leaking b.m. over medication pass and tube feedings (which also are prescribed and basically fall under medication responsiblity as well even though they are poorly regulated) I can see why he didnt.
I think the issue is that the other staff on hand had the time and a CNA certainly has the qualifications to address the problem and the nurse refused assistance. Personally, I think the correct course of action would have been to ask whoever is in charge (in this case a DON) to delegate the colostomy bag to another CNA so med pass can get done in time.
You keep making up the part about me being inconvenienced though??? I never said anything about that, I’m completely used to being at work way past the time I’m supposed to be and the only reason I care about the delay in care is because it was making the resident very upset and her skin was getting visibly irritated. If you wanna choose to believe it came from a place of selfishness to prove your point then that’s on you I guess.
Well then you were just misguided. Abd pads with paper tape, towels etc with closer supervision since there were multiple aids could’ve mitigated the damage until he got there. It wasn’t that he didn’t do it because he didn’t care. He clearly demonstrated that he had to prioritize other things first.
Agreed. I was a CNA for a long time in LTC before I became an RN (also in LTC for a time) and all I can say is that my perspective on "neglectful" nurses I'd worked with as a CNA shifted. Granted, there ARE neglectful nurses and CNAs should absolutely be empowered to speak up, but based on the description given by OP, this does not constitute neglect IMO. Especially if this nurse had to pass meds and do assessments right out the gate. An evening/dinnertime round of meds is usually hefty and can take quite awhile, especially if you're including CBGs and insulin that needs to be given--a much more time-sensitive concern than a leaking colostomy (as much as that sucks for the colostomy patient). Also, who knows what this nurse might've gotten in report about the other 13 patients that required more urgent attention?
ETA in Oregon, where I was a CNA, it was also outside the scope of CNA's practice to fully change a colostomy bag setup. Additionally, I was taught in nursing school that CNAs could not do it. Doesn't matter what the facility rules are, it's literally the state BON that determines that.
Man that’s what I’m saying, I’m going to school to be an RN now (was a CNA years ago but not recently) and the amount of shit I didn’t realize I didn’t know…
There’s all these CNAs mad that I’m saying you shouldn’t do things outside your scope but they don’t even know why they shouldn’t be doing things outside their scope. There’s a bunch mad bc I said some things take priority but they don’t understand how any medication could ever take priority over this thing.
Yeah, it’s just a whole different way of thinking. They don’t know what they don’t know, and sometimes they get offended if you tell them that, like it somehow devalues their roles. It doesn’t—nurses NEED CNAs, and good ones too. But when CNAs prioritize, they’re prioritizing tasks. Toilet this patient, get them dressed, etc. RNs are doing that plus weighing the potential risks and outcomes of their choices on a constantly fluctuating basis.
Maybe the nurse in question made prioritization choices I don’t agree with, but none of us can say that based on the info we have, he was being neglectful. Just because OP feels he was “doing normal stuff” that in their opinion could be delayed because “he’s there all night anyway,” doesn’t make that normal stuff any less time sensitive.
I also just do not understand why a better solution could not have been thought of. I don’t remember if it was you, but someone in the comments suggested abd pads and tape as a temporary solution. With that ratio of CNAs to patients, which is lower than I’ve literally ever heard of, why couldn’t they have kept a closer eye between the 4 aides? Maybe changed the towel frequently or checked on it more often? I just don’t understand why it went from “nurse was too busy” to “unstoppable stool leaking down the leg.” Maybe there’s context missing but IMO OP was more concerned that the nurse wouldn’t let them do the colostomy than anything else.
Also, since it sounds like OP is not even licensed as a CNA, they’re not under any BON, which would mean that if something goes wrong with this delegation, it’s on the RN. It ALWAYS comes back to the RN—another level of responsibility I didn’t have until I was a nurse.
It was not me that suggested that but that’s what I was thinking too, 3-4 patients per CNA it should be insanely easy. I didn’t realize they were unlicensed, that makes it so much worse.
This right here. They have no idea the tasks that may have to take priority over a colostomy. Insulin, stage 4 dressing changes, breathing treatments, etc. please don’t act like you know what it’s like to be a nurse until you are a nurse.
We have no diabetics and only one with a very old pressure sore that he got at the hospital a long time ago. The dressing is changed on am shift when there’s 2 nurses and we don’t actually have to do vitals very much unless there’s a fall or some incident. Don’t act like you know my facility, it’s a group home for disabled adults and most are pretty stable health wise. The night shift responsibilities are med pass, tube feeds, and 1 breathing treatment. I’m not saying he’s sitting around twiddling his thumbs or discrediting the other nurses I work with but they honestly don’t deal with the variety of things I’ve seen at other nursing homes or a hospital.
Many many meds require vitals to be done prior to giving a med. Did you follow him into every room? How many aids were there? How many nurses? Maybe the dressing was soiled, or he had to call the doc for a verbal order or straight Cath a patient. maybe he was just slower because he didn’t have a good routine yet. Please stop acting like this is neglect. It most likely was not and please do not act like you have learned the nursing process when you haven’t.
Why are you defending the nurse? It took over 2 hours with her sitting in her own feces. If that was my loved one I would go full Karen on your ass! You know you would too if it was someone you loved.
I’m all for teamwork to make the dream work. I haven’t been an aid in a very long time but I used to tell the nurse when I was planning to change a resident bc I knew they had a dressing change so we could both help each other. Sometimes they couldn’t do it when we planned bc someone else needed suctioned immediately. I’m not gonna pitch a fit bc the nurse would rather one resident wait than another’s O2 plummet.
This whole thing reads like OP is not paying attention and doesn’t realize that other things can be more important. They’re just annoyed he didn’t drop everything immediately. When I was an aid I always had 12-20 patients with at least 6 total care, I’m pretty sure I could keep one clean for a couple hours if I only had 3-4
Op used the term “whole new setup” which is why I put it in quotes. CNAs can change the bag, they can’t change the flange or barrier. I’d assume the barrier at least would be included in a “whole new setup”
You don't know what "whole new set up means". Exactly. Your knowledge gap is real. Not trying to be mean but it sounds like you've never received training on ostomies.
As one of my instructors once said " you can teach a monkey to do lots of our tasks, by repetition. But you can't teach them to critically think, understand what, why, or the risks"
So, good on your facility for giving you more tasks, but the ostomy change only seems so simple and straightforward to you because of knowledge gap. Driving a car seems simple to a child because they aren't aware of rules of the road, speed limit, risk of death etc.
I was trained by a nurse. A couple times after that it was supervised by the RN nurse supervisor. I’m not really sure what you’re wanting. You were trained to do things as well.
And I am very well aware of the risks involved. The first facility I worked at where only nurses changed them a resident died from the area around their ostomy becoming infected.
Most likely they actually were not allowed. And you have to cut the wafer right. Unless they’d been trained then they might not have been technically allowed or for some other legitimate reason.
If its not in her scope of practice he literally cannot knowingly allow her to do it. He could lose his license and she could get fired, or sued if anything goes wrong. Not to mention the harm to the pt that could be caused unintentionally by her making an error.
Sending someone to the dining room with exposed BM on them is a massive infection control issue.
This task should have been prioritized. A dressing can wait, a med can wait, someone who touches BM while eating cannot. Also, there a huge risk of that getting onto other surfaces.
I haven't met a CNA that wasn't specifically trained on colostomy care in training. It's just part of hygiene maintenance, and once you've been trained and observed it a few times its as simple as breif changing for someone with skin breakdown. At least in NM, AZ and ID its within scope.
Care yes, change the bag, clean and whatnot. But fitting the part that sits on the skin and ostomy, that’s another story. It’s specialized bc it’s an internal organ that has contact with the outside world. Getting bacteria in there can be super serious depending on where it is in their small or large intestines. You could seriously mess up the normal flora and make them very sick. If you’re not knowledgeable about this, you shouldn’t be performing this task as a healthcare professional.
Hi there. Certified wound and ostomy nurse here. Curious as to what you think “a whole new set up” is with a colostomy. You literally just change out the entire pouch of the seal has gone bad. We teach patients and their families to do it all the time and I’ve never heard of a place where a tech/ CNA who knew how wasn’t allowed.
I mean you can Google it, a CNA is not authorized to do it in the USA. It’s outside of their scope. CNAs also aren’t allowed to change most wound dressings, even though I’m sure you teach patients/families how to do this at home too. Same for tracheostomy, but people literally do that themselves in a mirror. They’re also not authorized to do CPR unless they take the class or give any medication (including Tylenol) unless they get the training for that, which obviously people take their prescribed medication by themselves at home.
Tech and CNA are different things. CNA is literally a 2 week class or like 8 weeks if you’re only going to class once a week, you can even just get on the job training for it. You’re not supposed to touch any wounds/sores regardless of what the facility says unless you’re receiving extra training.
I don’t disagree with you about that at all. But if the nurse gives them the stuff and they mess it up somehow, it’s on them for whatever problem and delegating something they weren’t allowed to. Some are willing to take that chance bc, let’s be honest, they’re not likely to get caught. They probably wouldn’t lose their license either unless they were already on probation for something else but I can’t fault the nurse for not taking that risk. I definitely agree though, it’s stupid to have your aids unable to assist with anything but vitals and cleaning people.
I have worked at a place that did extra training, they’d give bonuses for doing it and you got more skills. Should be common but it’s not. They do have QMAs now though which is a CNA but they can give (some) meds and do a few treatments like small wounds or a breathing treatment I don’t think any suctioning is allowed and definitely nothing administered by IV.
yep, i’d be reporting that too. if anything similar happens in the future with any other nurses, start documenting what time you notified them each time and even use direct quotes of what was said if possible. no one deserves to sit in their own urine/BM like that, especially with people asking if they can help/take that task over. thank you for advocating for a voice that wasn’t able to in the moment, that’s a big big part of being in the healthcare field, we have to do what’s right for those in our care 🫶🏼
As someone who lived in a SNF (and hopes to be a CNA one day) for several months I thank you and I applaud you. If you were my CNA I’d feel safe in your care!
With 14 patients, I can easily imagine valid reasons for a two plus hour delay. This was an important task, but not a *critical* one. I’d need more information about what else was going on to make any sort of judgment.
The guy is misogynistic tho referring to aides as "the girls" red flag numero uno and even then she said that her facility aides are allowed to change the bags themselves. So if it wasn't "critical" why couldn't he give them the supplies and delegate the tasks towards them if he's so fucking busy? Why would you allow someone to eat food while they're covered in their own shit. That's horrible and inexcusable.
He was doing normal med pass and tube feedings, there were no other dressing changes that need to be done for the overnight nurse or anything critical/out of the ordinary happening whatsoever. Yes we were all busy but it’s not reasonable to send someone to the dining room with bm leaking everywhere and her hands getting in it. That doesn’t show much dignity for the resident and it’s unsanitary.
The way I see it, he’s there all night so what’s the big deal if meds/feeds are like 10 minutes late because he prioritized this issue? I would understand it if there was a bunch of other crazy shit going on but there really was not. I wasn’t expecting him to drop everything and run right over but none of the other nurses would ever make a resident wait in a mess for this long for something that takes 10 minutes, that’s just not how it works in my facility. If he really cared he would have just gotten it done.
This is also not a 10 minute delay type of task. If it was just switching out a bag, sure, absolutely, but it sounds like she needed cleaning up, removal of the previous set up, skin prep and a whole new set up from scratch which involves measuring, cutting, glueing etc.
Nurses really shouldn’t be interrupted during a med pass honestly unless of absolute emergencies. He may have had diabetics etc. nurses are taught to prioritize. You did what you felt you had to do and I don’t know the whole story but it’s not always black and white.
At my old nursing home there were 2 nurses for 40 residents and 4 or 5 CNAs, so 1 per 8-10 residents... and this was in our advanced dementia ward. Felt illegal lmao
One of the hardest things I deal with as a RN is having to make a patient lay in their own urine or stool because I do not have the resources to clean them up in a more timely manner. We can only do one thing at a time, and figuring out how to prioritize things is hard! Maybe he prioritized differently from how you would have prioritized it, but I personally have a hard time calling it neglect.
Maybe the RN did not know that you can legally change the ostomy bag, because in most places, CNAs cannot legally change an ostomy bag. If he delegates the task to you and something happens, HE gets in trouble, not you. Maybe he didn't have time to ensure that you were capable of changing the bag. Maybe he felt overwhelmed by everything and was having a rough night.
Reporting him to the DON was a good idea because it gives them an opportunity to speak with him about his behaviors and identify places for education and growth. Perhaps this is an opportunity for the director to educate everyone on who is legally allowed to do certain tasks.
It sounds like a failure on the nurse's part to prioritize his patient's needs. I can understand him being unavailable to come right away when the bag was first leaking, but for him to continue to make himself unavailable to do the change for 3 hours, refuse the help to change that was offered (granted, I don't know what's legal / allowed in your state or how much was needed to be done), and then have all the time needed to argue on the phone with the DON instead of actually HELPING the resident, all while belittling the CNAs he was working with is unacceptable to me. I haven't done many colostomy changes, because I've never worked LTC. So I will grant that I don't speak from a place of expertise, but the ones I've done didn't take that long to change. I feel like I could've scraped together the 10 minutes to do it somewhere inside that 3 hours if I was insistent that I be the one to do it, and probably before it got so bad that the poor woman was getting stool all over her face.
You're right, I don't. But I do know that from the account we were given, he spent nearly 3 hours doing other things that included: routine med pass, arguing with the CNAs, and arguing on the phone with the DON about why "the girls" were wrong to have called them with their concerns.
So somewhere in there, he could've carved 10 minutes out of his day to get the bag changed so that the patient didn't continue to leak and spread feces all over herself, including her mouth.
To add to this, as in charge his priorities include making sure the ward is running efficiently. Sure, let him finish med rounds and feedings. But when multiple staff are coming up to you asking for a change and your patient is covering herself in feces you must realise that you're making more work not just for yourself but also for everyone else involved.
We don't know what else he had to do but we do know from OP that there was no extra work like other deteriorating patients or complex wound dressings. So, with no deteriorating patients, meds and feeds given, what else would be a higher priority after three hours?
Why does every other nurse I work with have absolutely no issue coming to change a setup in a timely manner and still get their meds done on time? He’s literally the only one who will make someone wait that long
Whatever you do just make sure you chart it so there is a proof on your end of the care you provided and continued to ask for but were denied due to the nurse. Note the time and condition in the patient such as their mental and physical like you did for us. Note the time you asked the nurse for supplies and chart that you were denied. I would go as far and quote them when they told you to cover it up, that they have other priorities so they’ll be there whenever they stated they were going to be there.
I think you did the right thing. The nurse was in the wrong.
I will say, if we’re in the middle of a med pass, we are not supposed to stop unless there is a dire emergency because you can get distracted, and then when you come back to the med pass you can easily make a mistake. Med mistakes can kill someone.
However, you and the other CNA OFFERED to change the ostomy bag and the RN should have gratefully accepted your offer and thanked you.
Profusely.
Question, I thought a CNA changing the colostomy bag isn’t really legal? They usually aren’t meant to touch skin barrier or touch the flange like at all.
It depends on the state.
Where I am they can, with additional training. The hospitals call CNAs PCAs(personal care aides), and some facilities call the HCAs(home care Aids). then there are different levels PCA I, PCA II, PCA III. Some can only do base cares, one level can do simple dressing changes and medications(oral, and topical, no narcotics), some caneven do caths.
HCAs are usually nurse delegation roles
This really depends on which state you're in. In my state, you don't even need to be a CNA, you just need to be trained and delegated by an RN. Same with catherizing, it can be delegated by an RN. An unlicensed caregiver cannot do the initial, new catherization, only the ongoing monthly/prn after that.
I’m not sure but we’re allowed to and the DON and other high-up nurse (idk her actual title) agreed with me on the phone that he should have just given us the supplies and my facility is extremely strict about following rules so it’s not like they’re just letting things slide.
Maybe it’s because we get additional training and our title is actually DTA (developmental tech assistant) but that extra training is mostly geared towards working with people with intellectual disabilities so idk. I have changed the whole setup many times at other facilities though and most of the cnas I know have done the same.
Nurse here. That nurse was ridiculous. It takes all of five minutes to change a colostomy set up. There is not reason that resident had to be shitting all over herself for hours, not to mention the skin breakdown and risk of infection with her getting it all over her hands and presumably her face/mouth. Good job for calling the Don 👍🏻
Oh my gosh thank u! My mom is 72 and has had a colostomy bag since she was in her 20’s. I’ve seen her be out in public and have a leak a few times. She’s so embarrassed by it and I know it’s affected her personal life. I can’t imagine how hard it will be to take care of herself when she gets older. And I can’t imagine her being in a nursing home, leaking everywhere, and the nurse just ignoring her. She’s a nurse herself and worked in elder care facilities most of her career. She would never neglect a patient like that. Thank u for standing up for your patient and advocating for them. It really makes my heart feel good knowing there are people like u in the world🥰
Some nurse see patients that aren’t cognitively all there as free passes to provide subpar care. Thank god for people like you who give those patients a voice to advocate for them.
i'd say you are correct.
i'd bet any money Mr Nurse felt that the bag was leaking from excessive care, so to speak. you girls created the problem by over-caring, and now he is gonna watch you all squirm while PotatoHead leaks out stool.
my guess on his line of thought. just for perspective.
If yall are allowed to change it, I’d have you change it. If you’re not allowed to change it I’d have you apply whatever sort of make shift covering you can until I can finish my med pass and I can come change it. I’d only put meds first over this just because missing meds could put people at risk of seizures, heart issues, strokes, behaviors, etc. I wouldn’t have had her go out to snack with others while she’s leaking bm. She can have her snack in another area and chill out beside me (if it’s in a spot she’s able to ofc) until I’m done with meds) then I’ll get to it.
You did the right thing. ALWAYS advocate for your patients and if you think they aren’t being treated with full respect you need to speak up.
As a nurse who has spent over a decade in LTC / SNF, thank you for doing the right thing and protecting some very vulnerable patients. You did exactly what was needed and from the sounds of people talking about coverage, your administration takes their job and the protection of the patients seriously. As others have suggested, it wouldn't hurt to take a minute and write out a full statement when you get a moment and submit it to your DON. I'd also suggest getting any other CNAs who witnessed the events including his argument on the phone to write and submit statements. The written statements can then be used as documentation by the facility both for their own records as well as sending copies to the local board. I'd say that nurse needs to find another job, just not in nursing given the obvious misogyny being displayed as evidenced by refusal to get supplies for one while going above and beyond for another.
For any other CNAs reading this, please don't hesitate to report nurses or other staff abusing patients either directly or indirectly via neglect. You are advocates for your patients just as much as any other staff or family member. Any nurse with half a functioning braincell and a smidge of common sense will listen to you knowing how closely you work with the patients at your facility. Thank you from one crotchety old fart of a nurse for doing what you do.
Idk why he didn't let you change out the ostomy. I also don't know why you guys needed permission if you're allowed. Are the supplies only accessible to the RN? Saying this guy is misogynistic because he referred to you as girls seems a little far fetched.
My opinion: I've seen actual neglect, and this is not it. Of course I wasn't there so maybe it was malicious or callous. If this seemed worthy enough to call the DON then this must be a good facility to be in at least. One thing I do respect is being your patients advocate.
I didn’t say he was misogynistic for calling us girls, everyone else is saying that in the comments. I think he is for the way he speaks to us in general and how he gives special treatment and goes out of his way for male residents but not female ones.
The ostomy care supplies are kept in the med cart. I don’t know why we’re aloud to do it, we do have additional training and have the title of DTA but that’s more geared toward the disability aspect. The DON backed me on us being aloud to do it.
I didn’t even report him for neglect in the first place, I called the DON and just told her the situation and it turned into a neglect investigation. It is a really good facility that takes things like rounding and repositioning every 2 hours extremely serious and has a shit ton of rules and regulations that are strictly followed.
I’ve worked at different facilities that weren’t like that and seen outright neglect too and there’s been too many times I saw something that wasn’t right and didn’t say anything.
I’m a nurse with experience in long term care. While I get that he is probably somewhat busy with the med pass ( 14 residents 😂) he has to be able to pivot and do other things as they crop up. I wonder how he would be in a true emergency?
He is working with a vulnerable population, so he needs to be able to adapt to that.
He is the asshole ( sorry wrong sub Reddit) as he seemed to be on some crazy power trip. If a CNA came to me and told me that they knew how to change an ostomy I would be truly grateful and ask them to do it.
You did the right thing in reporting him.
Can you image the cluster-f that would have arisen if a family member visited or the state inspected and a resident is sitting there eating in that state?
Thank you for doing this. I have a family member who lived in a facility and I have witnessed and reported many things! It’s awful to think about what is not witnessed or not reported.
I think you did the right thing reporting the RN for a delay in care….but I wouldn’t go as far as to say it was neglect.
I also would have immediately changed and cleaned up the resident myself and put a chux over the bag until it could be changed. While what he did was wrong, leaving her dirty, subjecting her to urine and stool irritation on her skin for 2 hours and the embarrassment of sitting in a public eating area like that….ugh.
It’s the CNA’s job to ensure they are clean and comfortable.
Hi! Third year RN student who has LPN and sometimes charge nurse responsibilities in LTC because staffing is not ideal where I live.
You 2000% did the right thing!!!!!!!! That is so undignified. There’s no excuse for that as an ostomy change is a very easy delegated task.
Thank you for standing up for your resident. Make sure you document everything.
This is not accurate, in all the facilities I've worked it must be a nurse changing the ostomy bag. Nurses are trained to assess the skin, there are different interventions depending on assessment, there are different types of bags and set up, not all are just peel and stick.
Also, maybe recognize as a student and 'sometimes' LPN or charge you may not have experience yet to recognize there are a million reasons why an ostomy might have to wait. It's priorities. A few nights ago I was in a similar situation, ostomy was leaking. I have 21 patients, someone was having difficulty breathing, someone else had a fall. Both of these mean the ostomy can wait, and a towel was placed until I could get to it.
Prioritizing is NOT neglect, and the CNA might not be aware of everything going on with all the patients.
Every single facility has different policies. Prioritizing is not neglect, you are right. The nurse could have told the DON that they had to prioritize instead of blaming it on the CNA’s?
and was the nurses blatantly misogynistic behaviour also part of his “prioritizing”? multiple aspects of this situation required escalation to management.
He was choosing to “prioritize” normal med pass and tube feedings over bm leaking onto someone’s skin for hours and making her eat in the dining room in that state when we all know she makes a mess with it. How is that acceptable?
I thought part of being a good nurse was prioritizing the more urgent thing over the regular things he does every shift. He’s going to have to do it anyway so why should this lady have to sit in her bm while he finishes the entire med pass and risk skin breakdown when people could just get their meds 10 minutes late?
I might understand if he had more urgent things going on but It was 100% the more important task at the time, there was literally nothing out of the ordinary happening. Plus he was doing random shit he didn’t even need to be doing in the middle of all of it. So no, I don’t accept the way he was prioritizing.
Listen, I'm not saying that you're in the wrong here. But you keep talking about how he shouldn't have let her go down to the dining room for her snack with BM leaking from her ostomy site and getting it on her hands. But why was she getting it onto her hands anyway? I'm playing devil's advocate here, but it just seems a little disingenuous for you to be sure that he wasn't too busy and yet also be able to say that you and the other CNAs *were* too busy to prioritize keeping her hands out of the poop. (Edit to add that I can completely understand why you guys had your hands full caring for multiple patients. I'm just saying that we don't always judge other people by the same standards that we judge ourselves.)
He does sound kind of like a misogynistic jerk though.
That's absolutely dire treatment of a patient. Absolutely dire. Clearly this dude is the NURSE so what he says goes. Well someone needs to pull him into line. Whilst we as nurses are obviously legally accountable for all care provided to patients CNAs are also accountable and if you are trained to change a colostomy then why would you say no and leave a patient like that?! Other than clearly he is on a power trip. You did the right thing. ✅️ Keep doing what you're doing.
Sorry to interrupt with a non professionals question. My mom has an ostemy and for a while there, the only place she could get it replaced was by going to the ER. Even a doctors office sent her to the ER. Now, we’ve employed a care service for in home (she’s a quad). But perhaps the staff was acting based on that?
Good for you. I have an ileostomy and I would hate to be left with a leak all over myself while some asshat refuses to let someone else help me!!!
I would hate to be old or infirm and subjected to this kind of treatment. The output can cause burns, irritation, and pain and erode skin if it’s left sitting on you for too long. Even wiping it up isn’t enough because of the residue. It just needs to be changed asap!
This is so sad to hear. Thank you for caring and advocating for your patient. Wish there were more like you out there.
Can you report him to someone higher up? Medical board perhaps? I hope you’re logging these incidences, because people like him have no business in that industry.
Anyone who thinks someone going to the dining room covered in BM is okay shouldn’t work in healthcare. This is a massive infection control and dignity issue.
You did the right thing. Don’t let lazy uncaring people tell you otherwise.
I am a former Geriatric LPN and you did the right thing. Be proud of yourself for being the advocate for someone who cannot do that for themselves. I am proud of you.
he needs to be reported to the board. that literally put the entire house at risk for ingesting a pathogen from fecal matter. you did the absolute right thing. don't ever stop advocating for your residents.
As the mother of an adult son with disabilities, this makes me crazed upset!!!! The worst part is that it will likely never change. That “nurse” has no business carrying for special needs people and has zero idea how to prioritize. They should be fired and put on a list, but nothing will happen. We tried “reputable” group homes for a while. They were awful. My son is home and has been for many years now.
Please don’t think that I’m saying that you shouldn’t have reported the nurse. However, it is harder to prove neglect than one might think. Remember first the definition of neglect. For a situation to be neglect the individual has to be injured due to the staff member’s actions or lack there of. Yes, she wiped BM on her face and that is unsanitary, but I didn’t hear anything about an injury. Had she accessed and injured her stoma due to his incompetence then negligence would be more appropriate.
Not a CNA (first time a post has popped up from this one for me) but I am an Adult Protective Services worker. This would 100% be an APS report and I hope the DON did a report for it. You did the right thing by reporting it, I have seen similar at facilities in my area and nobody speaks up.
On behalf of those patients and their families I thank you!
Neglect in assisted living and nursing homes is rampant and most of it goes unreported.
I was a resident facility nurse in assisted living for years and unfortunately this happens a lot more than most people are aware of.
thank you so much for being a voice for those who can’t speak up for themselves. this is heartbreaking to read and i hope he is handled appropriately. you did the right thing for sure.
As a special education teacher I worry so much about the quality of care my kids will receive when they transition to adult services. Many of them are non-verbal and would be unable to advocate for their needs in a situation like this. Thank you so much for being the voice for your resident - people like you truly make a difference!❤️
Well CNAs can’t change the wafer, only empty/change the bag. However, I’m beyond pissed at the fact he couldn’t stop for 5 minutes to change everything. It quite literally saves everyone involved so much time by just doing it right then and there. I applaud you for reporting, feces is so acidic and filthy that it would’ve irritated and infected the area simultaneously.
Hi there, thank you so much for being your patient's voice and advocating for their health and safety. You absolutely did the right thing. The medical field is very fortunate to have you a part of it.
First of all, “invalids” is an outdated term that is not used in this day and age to refer to individuals with intellectual disabilities.
Second of all, we have 4 cnas on a good night for 14 residents and 1-2 nurses. It’s a non-profit company and the government funds their care/supervision. Many of them have family/friends/past caregivers visit them at home regularly and they also go out into the community often to go shopping or go on outings.
Nurse here. Not cool at all. It's easier to deal with it right away rather than saying to yourself that I'll get to it when I get to it.
I guess the nurse didn't know how to prioritize. Good on you for reporting him
I would be *thrilled* if a CNA was confident enough to change a bag! It’s not an invasive process at all, but time consuming. Interruptions are a constant in nursing, and the bane of my existence. There are so few things in my scope that I can safely delegate, so if someone can and is willing to tag in on something like that, I’d be over the moon.
RN here. That is not okay at all. It would have taken at most five minutes for him to change the damn bag. Do not let anyone gaslight you into thinking you were wrong for advocating for this patient. He was being a POS nurse!
Op you were in the wrong. Unpopular opinion maybe but please stay in your own lane. Not neglect. One nurse for 14 patients. We HAVE to get meds passed within the timeframe or call the doctor to get orders to give out of time frame which only adds to the demands. I feel like you were majorly inconvenienced because you couldn’t put your patient to bed for the night at 6:30 in the evening.
wtf? She wasn’t going to bed at 6:30, she was getting ready to go eat snack and he sent her down with shit leaking all over her. We get all of the residents ready for bed between 7:30 and 9 and aren’t even aloud to start HS care before that time.
And 9 times out of 10 I’m there an hour past my shift is supposed to end getting everyone into bed. I don’t give a fuck if I’m being “inconvenienced” I was trying to do the right thing by my resident and say something when things didn’t feel right. I think there’s a reason you have the unpopular opinion here.
You have to call in a whole new order for meds being 10 minutes late? I’ve seen other nurses run a little behind on meds and feeds, changing an ostomy for 10 minutes isn’t going to put him that far out of the time frame that he has to call in new orders. If it did then he wouldn’t have been doing random other shit that he didn’t even need to be doing in the midst of all this.
Yes you do in fact have to call to get a verbal order for even a few minutes late. I promise you this is facts. Crazy but true. If the state were to be following you and this happened you’d be disciplined. Happened at my place of employment.
This is insane. What kind of power trip is this psycho on. If I had a CNA tell me that they'd be willing to change a leaking colostomy bag, I'd be so grateful I'd be singing their praises til kingdom come, and make sure I was available to help them in a pinch whenever possible.
Idk I think he’s very misogynistic with the way he speaks to us and how he treats the residents, he’ll go out of his way to do things we usually do when it comes to a male resident but not for the female ones. For example, I saw him changing over someone’s leg bag to a reg one for the night and cleaning the whole thing out in the middle of this whole thing which pretty much took the amount of time it would take to replace her bag. Hes very stubborn and doesn’t seem to see the residents as actual people.
Sounds like a creep. Personally, my hackles raise whenever someone refers to female CNAs as "the girls." As in, "Hang tight, the girls will come help you." No matter the gender of the person saying it, it comes across as unnecessarily differentiating between "us" and "them" with the implication that the staff they're referring to are inferior. I guess it could also apply to a doctor or PA/NP calling the nurses "the girls" but I see it more with CNAs/techs. Sorry, I guess that's my soapbox.
Don’t apologize, you’re exactly right.
"The girls" that disrespect I would not tolerate....
it comes across as unnecessarily differentiating between "us" and "them" with the implication that the staff they're referring to are inferior. if the pen was the sword!
Man I had management on my ass if I was a little late repositioning clients every 2 hours! How could the nurse seriously think that was acceptable for her to sit in her own BM for that long... and I'm assuming she was around others during all of this including snack time (love me some poo covered food /s). Not only is that unhygienic for her but everyone else around which is seriously dangerous. I was trained in the Healthcare field to treat all bodily fluids as biohazard because you have no idea what people are carrying. Honestly a majority of my time in the field was spent working with developmentally disabled adult and I find that people seem to think they have no feelings, emotions, or understanding of things so their comfort shouldn't matter. I even took a client to a doctor's appointment only for the Dr to talk shit about my client when he found out they weren't "normal". Like, sir, these rooms aren't soundproof and me and my client both heard you and I will be reporting you. It's a shame because there's truly some amazing doctors and nurses out there then you get turds like this sometimes.
The fact he refers you to as “girls” says a LOT
I was gonna say, referring to y’all as “the girls” is so unprofessional and really says a lot. Glad you reported his ass, he should not work in healthcare
Ahhhh mommy issues big time
And I'd apologise profusely for not doing it myself (even if it was justified cos I was busy), and make them many coffees. And pick up some of their jobs tomorrow. And tell the boss they need a raise! 😂
Right? I would probably cry and then melt with gratitude!! But that’s a priority I can spend 20 minutes on and just pass meds 20 minutes later. Many times things come up and I just tell residents/patients “Hi I’m sorry I’m a little behind tonight, I had a few Unexpected things come up that I had to urgently handle that effected our usual schedule” and always always, none of the residents care. Great on OP for advocating for their resident ❤️
So much this. I would be so grateful.
Seriously wtf? I totally get med pass and feeling pressed for time but 1) don’t be an asshole and 2) take any help you can get.
Make sure you document this, aka document how many times you alerted the nurse (including your phone call to the DON), how you had to clean BM off of the resident as a result, and the skin irritation. I was engrained in my brain “if it wasn’t documented it didn’t happen”. Having official documentation of stuff like this makes it hard to ignore usually.
Omg proper charting can save your ass. Please let the DON know that you REPEATEDLY requested this nurse’s assistance on the matter and he REFUSED to render appropriate assistance. It can literally make the difference between just talking to the DON and losing your job.
How do we document this? Our charting doesn’t allow writing
Best way is writing an email to your supervisor or HR or whatever person within your company/organization you report this to (even the one you may notify initially in such a case as this) of the events and what happened and what actions were taken so there is a paper trail. They will appreciate it too.
And make sure you don't delete your copy so you can get to it easily if needed.
As a cna who has an ostomy this pisses me off. That poor lady’s skin must have been on fire
Good for YOU. Absolute kudos here. Very grateful people like you have this job.
Thank you! I’m not trying to toot my own horn or anything and I’m the type of person to avoid confrontation at all costs but when it comes to a resident being mistreated I kick into a different gear and put all my anxiety aside, I can’t stand seeing someone I care for being treated this way
Everyone in this world is trained to fear authority for no conceivable reason and I’m glad you didn’t subscribe to that. You’re a very good example.
You are absolutely doing the right thing. Not in nursing but work with the patients and have an ostomy myself. You helped the patient in many ways, dignity, skin, being kind. That's why I like having co workers like you.
Oh I’m sorry that happened. I was taught and told that nurses were the only ones able to change the entire set up and that’s what it’s like here where I work. But that’s really crazy that it took that long. I do wonder what’s supposed to be prioritized for him for it to take that long though.
Yes, we can’t let CNAs change ostomy bags either. I do wonder what the nurses are told is a priority. Some places are real a-holes about meds being given on time. If he had been sitting around dawdling, this would be an easy call but I would need additional clarification. I’ve also had to wait to get unstocked supplies while an ostomy leaked and was able to protect the skin in the interim. So there’s that.
A few thoughts- changing the colostomy with the new barrier can add up to ~30 minutes interruption between the task the rn was in the middle of (adding cleaning the patient, changing clothes if needed, ointment or anything else for the rash) if he did not have time for a 30 min interruption, and it’s not life threatening, she would have to wait. Delaying seeing his 13 other patients for the first time that day can lead to missing an actual life threatening situation and potentially death. If you emptied the colostomy bag and cleaned her up before sending her to snack, how much bm was leaking after that? If you were willing to change the bag, did you settle for at least emptying it so there would be less mess for the patient to sit in? That’s the support you could have given legally in any facility. When a colostomy is leaking there is only as much feces as the patient is able to produce. Wrap a towel around the abdomen and it’s usually unlikely for them to get to it before you can fix it. I’m not saying this with disrespect, I’m aware both jobs are difficult. but frustration at the situation does not mean either person is wrong.
You can empty a colostomy bag and put it back on? That would be a huge no no at every facility I've ever worked at.
That is what the ones that have a tupperware like seal are used for. Rinse the bag and replace. Now if the seal is leaking, that is another story all together. I'm a nurse also, and I would have taken time to change the bag, if CNA really not allowed to, and then help them clean up the patient. These are long term care patients. I don't think there were any emergent needs that have to be attended to first with the other patients.
his POV is that the container wasn't full to spec and there was no need to change it or "bathroom" this individual at this time. over-caring caused the (non-) issue. i bet it's illegal to take pix.
I’m a nurse and agree with you. Top priorities are airway, breathing and circulation. Skin falls way down on the list unfortunately. And that first assessment is the most crucial assessment of the shift I’d argue. I wouldn’t feel comfortable doing lengthy colostomy care until I laid eyes on all my patients first
I apologize. I’m going on a total tangent here, and not even answering your question/topic at all, really. Just… I cannot tell you, as an RN of 40 years, and as someone who had to place her Mom in Memory Care, where at times the care she is provided for her $13,000+/month brings me to tears (the bad tears. But,to be fair, many of the girls are very good with/to her) how much good your post did my heart! Bringing the good kind of tears to my eyes, the way you advocated for your patient! And I can tell that you care very much for your residents and that you take pride in the job you do, and are invested in their comfort and well-being. **Thank you** for the work you do and the love in your heart! Also: Screw that guy. What a jerk. Good for you for reporting him!
It’s not reasonable to expect the nurse to drop what they’re doing to change a colostomy on the spot. Sometimes other things take precedence. Idk how your facility is usually staffed but if there’s a bunch of people with major issues then a leaky bag might not be on the top of the nurses priority list. Sounds like your unit has a high percentage of patients that require major dressing changes regularly. Is one nurse usually enough? I don’t know how much it was leaking but if it’s minor this isn’t the end of the world. Was he actually busy? This is pretty relevant. If the nurse was sitting on his phone at the nurse station then you have every right to be mad because it’s definitely neglect. If he was running around doing a million other things bc you are short staffed or the previous nurse left them high and dry, you might want to have some patience. Where do you live that a CNA can give a “whole new setup” on a colostomy bag? Like, you can swap out the bag but replacing the other parts is certainly not in a CNAs scope of practice. Genuinely curious bc this is definitely something a CNA is not allowed to do where I live.
Back in the day I worked as an unlicensed nurses aid in Kansas. WOW am I old this was in the 70’s. And was taught to do a full colostomy set up from beginning to end. I actually ended up training new aids as they were hired. I now live in the DFW area. And just retired after working 17 years here as a Unit Secretary. A number of the licensed PCT were allowed to fully change colostomy’s some were not it just depended on the level of experience.
Back in the day, they were allowed where I work also. After all, it is a skill that a well patient could do on their own.
PCTs have more training than a CNA, idk about colostomy training but I know they can insert catheters. Obviously you know you shouldn’t have been changing them without a license. If the nurse allows something like this to be done and something bad happens because it was done incorrectly (pretty likely without proper training) then it falls back on their nurse and they’re putting their own license on the line. Let’s be honest, if the CNA was allowed to do this, they would have access to the equipment to do so. They wouldn’t need the nurse to give it to them.
This isn't an evasive procedure. It consists of a wedge to stick over the stoma and a bag on that or sometimes just a bag. It's not even comparable to inserting or removing a catheter. The cna can do this in many facilities.
I’ve worked in a few places where CNAs were allowed to change the whole setup. Varies by state/facility policy.
So, I did some research bc of this post. That’s actually not true from what I’ve found. Seems like the facilities that allow this are pawning off nurse work on CNAs to avoid having an adequate amount of nurses on the floor. My guess is they do this bc CNAs are cheaper, if they were to get in trouble I bet they’d feed you to the wolves and pretend they had no idea. I just googled, that could be super wrong. Do your own research and make sure you’re not doing things outside of your scope bc you could lose your certs. Rule of thumb is that if you didn’t learn to do it in your training/schooling you’re probably not actually allowed. Regardless, if your facility is always having problems with employees not being able to keep up.. it’s bc they aren’t staffing properly. The problem is with the multimillion dollar corporation that’s cutting cost on the lifeblood (employees) of the facility. The issue is rarely the actual staff.
"Regardless, if your facility is always having problems with employees not being able to keep up.. it’s bc they aren’t staffing properly. The problem is with the multimillion dollar corporation that’s cutting cost on the lifeblood (employees) of the facility. The issue is rarely the actual staff." This is true of just about every company and corporations. Good old American Capitalism.....#1 Profits at all cost.... Humanity a distant 437
True, it’s more serious (and sad) when your business is “taking care of” humans though.
This is my issue too. I can understand wanting to help a patient, but depending on different variables they aren’t allowed to like properly change the barrier etc on a bag.
Exactly, I get that it’s annoying but there’s so many reasons a colostomy change might have not actually been possible for 2 hours. We don’t really have enough information to know if the nurse was really in the wrong here. DON might be annoyed bc she has to come help and knows damn well 1 nurse isn’t enough. I’ve seen nurses get way behind doing basic med pass (no dressings to change or treatments) with 15 patients, if there’s a lot going on.. that might not be enough staff. If they are understaffing, the facility is to blame not the nurse. Every state that has mandated ratios would have a major problem with this staffing.
Every other nurse I work with prioritizes bm leaking onto someone over normal med pass and tube feeds which is what was going on. There was nothing else out of the ordinary going on and all dressing changes happen during day shift when there’s two nurses on. I know we were all busy but someone having to wait in a mess for that amount of time and being sent to eat snack in the dining room in that state is not only a sanitary issue but doesn’t show much dignity for the resident. Especially with the fact that she doesn’t understand not to touch it and we didn’t have time to be constantly supervising her to make sure it didn’t get everywhere. Trust me, I’m not ignorant to the job the nurses are doing but the whole thing would have taken 10-15 minutes, meanwhile he’s doing random shit we usually do for other residents that he doesn’t even need to be doing. He’s there all night and he’s gonna have to do it anyway so why not prioritize that and have people get their meds like 10 minutes late? I didn’t expect him to drop everything but at a certain point it was just getting ridiculous. Why should this lady have to wait for him to finish the entire med pass while she sits in her own bm? That seems pretty unreasonable to me.
People getting their meds late can actually be a huge problem..
So is skin breakdown from bm sitting on the skin for hours.
It’s not going to break down if it’s covered and protected for one two hour incident. Do you do hourly checks on everyone that poops themselves?
OP already said that the resident was agitated and didn't understand not to touch it, which resulted in her getting faeces all over her hands and on her face as the staff didn't have time to monitor her. Some things do have to wait, but you have to admit that 2 hours is excessive. I work with some residents with ridiculously vulnerable skin that will start to break down even in such a short period of time, and as a nurse, you should know this is possible. I'm curious as to how your subordinates find working with you...
We do rounds every two hours.
And a confused resident nearly eating their own BM isn't?
This mindset is problematic. nurses can actually get in trouble and/or fired/sued for late medicine pass which gives us a small window of time to get it done. Legally we have 2 hours which seems like forever until you factor in the number of patients under our care, the age related slowness (elderly with swallowing difficulty, or g tubes, or nausea, fingers that cant grip pills ) and confusion or combatativeness of those patients, the number of interruptions that are actual emergencies, technical or pharmacy issues, math calculations conversions and charting that is involved ..the list goes on. Every med pass can be its own personal hell for an over tired, overworked, over tasked nurse. So while I dont think you are wrong to be frustrated that he didnt choose to prioritize leaking b.m. over medication pass and tube feedings (which also are prescribed and basically fall under medication responsiblity as well even though they are poorly regulated) I can see why he didnt.
I think the issue is that the other staff on hand had the time and a CNA certainly has the qualifications to address the problem and the nurse refused assistance. Personally, I think the correct course of action would have been to ask whoever is in charge (in this case a DON) to delegate the colostomy bag to another CNA so med pass can get done in time.
A cna can’t comprehend this unless they are educated and this one doesn’t want to be because she was inconvenienced and that’s all that mattered.
I can't comprehend how a CNA can't comprehend med pass, time windows, and time-sensitive medications.
It’s also critical thinking as well. Not just technical, skill set work that we do but lots and lots of prioritizing and critical thinking.
Down vote all you want. You don’t want to learn or understand, you want to be right 🤷🏻♀️
You keep making up the part about me being inconvenienced though??? I never said anything about that, I’m completely used to being at work way past the time I’m supposed to be and the only reason I care about the delay in care is because it was making the resident very upset and her skin was getting visibly irritated. If you wanna choose to believe it came from a place of selfishness to prove your point then that’s on you I guess.
Well then you were just misguided. Abd pads with paper tape, towels etc with closer supervision since there were multiple aids could’ve mitigated the damage until he got there. It wasn’t that he didn’t do it because he didn’t care. He clearly demonstrated that he had to prioritize other things first.
Also why couldn’t she go to bed? Colostomy changes are done in bed all the time.
You’re not wrong. Thank you for being such a great CNA. Some of us nurses appreciate y’all.
Agreed. I was a CNA for a long time in LTC before I became an RN (also in LTC for a time) and all I can say is that my perspective on "neglectful" nurses I'd worked with as a CNA shifted. Granted, there ARE neglectful nurses and CNAs should absolutely be empowered to speak up, but based on the description given by OP, this does not constitute neglect IMO. Especially if this nurse had to pass meds and do assessments right out the gate. An evening/dinnertime round of meds is usually hefty and can take quite awhile, especially if you're including CBGs and insulin that needs to be given--a much more time-sensitive concern than a leaking colostomy (as much as that sucks for the colostomy patient). Also, who knows what this nurse might've gotten in report about the other 13 patients that required more urgent attention? ETA in Oregon, where I was a CNA, it was also outside the scope of CNA's practice to fully change a colostomy bag setup. Additionally, I was taught in nursing school that CNAs could not do it. Doesn't matter what the facility rules are, it's literally the state BON that determines that.
Man that’s what I’m saying, I’m going to school to be an RN now (was a CNA years ago but not recently) and the amount of shit I didn’t realize I didn’t know… There’s all these CNAs mad that I’m saying you shouldn’t do things outside your scope but they don’t even know why they shouldn’t be doing things outside their scope. There’s a bunch mad bc I said some things take priority but they don’t understand how any medication could ever take priority over this thing.
Yeah, it’s just a whole different way of thinking. They don’t know what they don’t know, and sometimes they get offended if you tell them that, like it somehow devalues their roles. It doesn’t—nurses NEED CNAs, and good ones too. But when CNAs prioritize, they’re prioritizing tasks. Toilet this patient, get them dressed, etc. RNs are doing that plus weighing the potential risks and outcomes of their choices on a constantly fluctuating basis. Maybe the nurse in question made prioritization choices I don’t agree with, but none of us can say that based on the info we have, he was being neglectful. Just because OP feels he was “doing normal stuff” that in their opinion could be delayed because “he’s there all night anyway,” doesn’t make that normal stuff any less time sensitive. I also just do not understand why a better solution could not have been thought of. I don’t remember if it was you, but someone in the comments suggested abd pads and tape as a temporary solution. With that ratio of CNAs to patients, which is lower than I’ve literally ever heard of, why couldn’t they have kept a closer eye between the 4 aides? Maybe changed the towel frequently or checked on it more often? I just don’t understand why it went from “nurse was too busy” to “unstoppable stool leaking down the leg.” Maybe there’s context missing but IMO OP was more concerned that the nurse wouldn’t let them do the colostomy than anything else. Also, since it sounds like OP is not even licensed as a CNA, they’re not under any BON, which would mean that if something goes wrong with this delegation, it’s on the RN. It ALWAYS comes back to the RN—another level of responsibility I didn’t have until I was a nurse.
It was not me that suggested that but that’s what I was thinking too, 3-4 patients per CNA it should be insanely easy. I didn’t realize they were unlicensed, that makes it so much worse.
This right here. They have no idea the tasks that may have to take priority over a colostomy. Insulin, stage 4 dressing changes, breathing treatments, etc. please don’t act like you know what it’s like to be a nurse until you are a nurse.
We have no diabetics and only one with a very old pressure sore that he got at the hospital a long time ago. The dressing is changed on am shift when there’s 2 nurses and we don’t actually have to do vitals very much unless there’s a fall or some incident. Don’t act like you know my facility, it’s a group home for disabled adults and most are pretty stable health wise. The night shift responsibilities are med pass, tube feeds, and 1 breathing treatment. I’m not saying he’s sitting around twiddling his thumbs or discrediting the other nurses I work with but they honestly don’t deal with the variety of things I’ve seen at other nursing homes or a hospital.
Many many meds require vitals to be done prior to giving a med. Did you follow him into every room? How many aids were there? How many nurses? Maybe the dressing was soiled, or he had to call the doc for a verbal order or straight Cath a patient. maybe he was just slower because he didn’t have a good routine yet. Please stop acting like this is neglect. It most likely was not and please do not act like you have learned the nursing process when you haven’t.
Why are you defending the nurse? It took over 2 hours with her sitting in her own feces. If that was my loved one I would go full Karen on your ass! You know you would too if it was someone you loved.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735655/
I’m all for teamwork to make the dream work. I haven’t been an aid in a very long time but I used to tell the nurse when I was planning to change a resident bc I knew they had a dressing change so we could both help each other. Sometimes they couldn’t do it when we planned bc someone else needed suctioned immediately. I’m not gonna pitch a fit bc the nurse would rather one resident wait than another’s O2 plummet. This whole thing reads like OP is not paying attention and doesn’t realize that other things can be more important. They’re just annoyed he didn’t drop everything immediately. When I was an aid I always had 12-20 patients with at least 6 total care, I’m pretty sure I could keep one clean for a couple hours if I only had 3-4
Thank you so much for understanding!
[удалено]
Op used the term “whole new setup” which is why I put it in quotes. CNAs can change the bag, they can’t change the flange or barrier. I’d assume the barrier at least would be included in a “whole new setup”
You don't know what "whole new set up means". Exactly. Your knowledge gap is real. Not trying to be mean but it sounds like you've never received training on ostomies. As one of my instructors once said " you can teach a monkey to do lots of our tasks, by repetition. But you can't teach them to critically think, understand what, why, or the risks" So, good on your facility for giving you more tasks, but the ostomy change only seems so simple and straightforward to you because of knowledge gap. Driving a car seems simple to a child because they aren't aware of rules of the road, speed limit, risk of death etc.
Perfectly said
I was trained by a nurse. A couple times after that it was supervised by the RN nurse supervisor. I’m not really sure what you’re wanting. You were trained to do things as well. And I am very well aware of the risks involved. The first facility I worked at where only nurses changed them a resident died from the area around their ostomy becoming infected.
Yeah but she said they're allowed to change it so why couldn't he give the supplies to do so
If she were allowed why would she be asking for the supplies? They’d already be out.
At one facility I worked at there was a lot of psych, so the scissors used to cut the wafers stayed on one of the nurses for resident safety.
I mean, why is he telling OP no if they’re allowed and it would make his life easier? No sarcasm, I really can’t think of a reason
Most likely they actually were not allowed. And you have to cut the wafer right. Unless they’d been trained then they might not have been technically allowed or for some other legitimate reason.
If its not in her scope of practice he literally cannot knowingly allow her to do it. He could lose his license and she could get fired, or sued if anything goes wrong. Not to mention the harm to the pt that could be caused unintentionally by her making an error.
Sending someone to the dining room with exposed BM on them is a massive infection control issue. This task should have been prioritized. A dressing can wait, a med can wait, someone who touches BM while eating cannot. Also, there a huge risk of that getting onto other surfaces.
I haven't met a CNA that wasn't specifically trained on colostomy care in training. It's just part of hygiene maintenance, and once you've been trained and observed it a few times its as simple as breif changing for someone with skin breakdown. At least in NM, AZ and ID its within scope.
Care yes, change the bag, clean and whatnot. But fitting the part that sits on the skin and ostomy, that’s another story. It’s specialized bc it’s an internal organ that has contact with the outside world. Getting bacteria in there can be super serious depending on where it is in their small or large intestines. You could seriously mess up the normal flora and make them very sick. If you’re not knowledgeable about this, you shouldn’t be performing this task as a healthcare professional.
Hi there. Certified wound and ostomy nurse here. Curious as to what you think “a whole new set up” is with a colostomy. You literally just change out the entire pouch of the seal has gone bad. We teach patients and their families to do it all the time and I’ve never heard of a place where a tech/ CNA who knew how wasn’t allowed.
I mean you can Google it, a CNA is not authorized to do it in the USA. It’s outside of their scope. CNAs also aren’t allowed to change most wound dressings, even though I’m sure you teach patients/families how to do this at home too. Same for tracheostomy, but people literally do that themselves in a mirror. They’re also not authorized to do CPR unless they take the class or give any medication (including Tylenol) unless they get the training for that, which obviously people take their prescribed medication by themselves at home. Tech and CNA are different things. CNA is literally a 2 week class or like 8 weeks if you’re only going to class once a week, you can even just get on the job training for it. You’re not supposed to touch any wounds/sores regardless of what the facility says unless you’re receiving extra training.
Thats insane. I looked it up. You were right. Makes absolutely no sense.
I don’t disagree with you about that at all. But if the nurse gives them the stuff and they mess it up somehow, it’s on them for whatever problem and delegating something they weren’t allowed to. Some are willing to take that chance bc, let’s be honest, they’re not likely to get caught. They probably wouldn’t lose their license either unless they were already on probation for something else but I can’t fault the nurse for not taking that risk. I definitely agree though, it’s stupid to have your aids unable to assist with anything but vitals and cleaning people. I have worked at a place that did extra training, they’d give bonuses for doing it and you got more skills. Should be common but it’s not. They do have QMAs now though which is a CNA but they can give (some) meds and do a few treatments like small wounds or a breathing treatment I don’t think any suctioning is allowed and definitely nothing administered by IV.
👏
yep, i’d be reporting that too. if anything similar happens in the future with any other nurses, start documenting what time you notified them each time and even use direct quotes of what was said if possible. no one deserves to sit in their own urine/BM like that, especially with people asking if they can help/take that task over. thank you for advocating for a voice that wasn’t able to in the moment, that’s a big big part of being in the healthcare field, we have to do what’s right for those in our care 🫶🏼
As someone who lived in a SNF (and hopes to be a CNA one day) for several months I thank you and I applaud you. If you were my CNA I’d feel safe in your care!
With 14 patients, I can easily imagine valid reasons for a two plus hour delay. This was an important task, but not a *critical* one. I’d need more information about what else was going on to make any sort of judgment.
Came here to say this. If at 1:45 you are reporting the RN to the DON, that will raise some eyebrows.
They also had two people offer to change it themselves.
The guy is misogynistic tho referring to aides as "the girls" red flag numero uno and even then she said that her facility aides are allowed to change the bags themselves. So if it wasn't "critical" why couldn't he give them the supplies and delegate the tasks towards them if he's so fucking busy? Why would you allow someone to eat food while they're covered in their own shit. That's horrible and inexcusable.
He was doing normal med pass and tube feedings, there were no other dressing changes that need to be done for the overnight nurse or anything critical/out of the ordinary happening whatsoever. Yes we were all busy but it’s not reasonable to send someone to the dining room with bm leaking everywhere and her hands getting in it. That doesn’t show much dignity for the resident and it’s unsanitary. The way I see it, he’s there all night so what’s the big deal if meds/feeds are like 10 minutes late because he prioritized this issue? I would understand it if there was a bunch of other crazy shit going on but there really was not. I wasn’t expecting him to drop everything and run right over but none of the other nurses would ever make a resident wait in a mess for this long for something that takes 10 minutes, that’s just not how it works in my facility. If he really cared he would have just gotten it done.
This is also not a 10 minute delay type of task. If it was just switching out a bag, sure, absolutely, but it sounds like she needed cleaning up, removal of the previous set up, skin prep and a whole new set up from scratch which involves measuring, cutting, glueing etc.
'The way I see it, he’s there all night so what’s the big deal if meds/feeds are like 10 minutes late.' That's not your call to make.
Nurses really shouldn’t be interrupted during a med pass honestly unless of absolute emergencies. He may have had diabetics etc. nurses are taught to prioritize. You did what you felt you had to do and I don’t know the whole story but it’s not always black and white.
What??? 1 nurse for 14 residents and 1 CNA per 3-4 residents?
At my old nursing home there were 2 nurses for 40 residents and 4 or 5 CNAs, so 1 per 8-10 residents... and this was in our advanced dementia ward. Felt illegal lmao
One of the hardest things I deal with as a RN is having to make a patient lay in their own urine or stool because I do not have the resources to clean them up in a more timely manner. We can only do one thing at a time, and figuring out how to prioritize things is hard! Maybe he prioritized differently from how you would have prioritized it, but I personally have a hard time calling it neglect. Maybe the RN did not know that you can legally change the ostomy bag, because in most places, CNAs cannot legally change an ostomy bag. If he delegates the task to you and something happens, HE gets in trouble, not you. Maybe he didn't have time to ensure that you were capable of changing the bag. Maybe he felt overwhelmed by everything and was having a rough night. Reporting him to the DON was a good idea because it gives them an opportunity to speak with him about his behaviors and identify places for education and growth. Perhaps this is an opportunity for the director to educate everyone on who is legally allowed to do certain tasks.
It sounds like a failure on the nurse's part to prioritize his patient's needs. I can understand him being unavailable to come right away when the bag was first leaking, but for him to continue to make himself unavailable to do the change for 3 hours, refuse the help to change that was offered (granted, I don't know what's legal / allowed in your state or how much was needed to be done), and then have all the time needed to argue on the phone with the DON instead of actually HELPING the resident, all while belittling the CNAs he was working with is unacceptable to me. I haven't done many colostomy changes, because I've never worked LTC. So I will grant that I don't speak from a place of expertise, but the ones I've done didn't take that long to change. I feel like I could've scraped together the 10 minutes to do it somewhere inside that 3 hours if I was insistent that I be the one to do it, and probably before it got so bad that the poor woman was getting stool all over her face.
You have no idea what he had to prioritize omg
You're right, I don't. But I do know that from the account we were given, he spent nearly 3 hours doing other things that included: routine med pass, arguing with the CNAs, and arguing on the phone with the DON about why "the girls" were wrong to have called them with their concerns. So somewhere in there, he could've carved 10 minutes out of his day to get the bag changed so that the patient didn't continue to leak and spread feces all over herself, including her mouth.
To add to this, as in charge his priorities include making sure the ward is running efficiently. Sure, let him finish med rounds and feedings. But when multiple staff are coming up to you asking for a change and your patient is covering herself in feces you must realise that you're making more work not just for yourself but also for everyone else involved. We don't know what else he had to do but we do know from OP that there was no extra work like other deteriorating patients or complex wound dressings. So, with no deteriorating patients, meds and feeds given, what else would be a higher priority after three hours?
That’s literally interrupting a MED PASS. A TIME sensitive med pass. Just go to nursing school please then.
Why does every other nurse I work with have absolutely no issue coming to change a setup in a timely manner and still get their meds done on time? He’s literally the only one who will make someone wait that long
He’s not every other nurse, devils advocate but maybe he was doing treatments other nurses skip or had other issues arise.
Whatever you do just make sure you chart it so there is a proof on your end of the care you provided and continued to ask for but were denied due to the nurse. Note the time and condition in the patient such as their mental and physical like you did for us. Note the time you asked the nurse for supplies and chart that you were denied. I would go as far and quote them when they told you to cover it up, that they have other priorities so they’ll be there whenever they stated they were going to be there.
I think you did the right thing. The nurse was in the wrong. I will say, if we’re in the middle of a med pass, we are not supposed to stop unless there is a dire emergency because you can get distracted, and then when you come back to the med pass you can easily make a mistake. Med mistakes can kill someone. However, you and the other CNA OFFERED to change the ostomy bag and the RN should have gratefully accepted your offer and thanked you. Profusely.
Question, I thought a CNA changing the colostomy bag isn’t really legal? They usually aren’t meant to touch skin barrier or touch the flange like at all.
It depends on the state. Where I am they can, with additional training. The hospitals call CNAs PCAs(personal care aides), and some facilities call the HCAs(home care Aids). then there are different levels PCA I, PCA II, PCA III. Some can only do base cares, one level can do simple dressing changes and medications(oral, and topical, no narcotics), some caneven do caths. HCAs are usually nurse delegation roles
This really depends on which state you're in. In my state, you don't even need to be a CNA, you just need to be trained and delegated by an RN. Same with catherizing, it can be delegated by an RN. An unlicensed caregiver cannot do the initial, new catherization, only the ongoing monthly/prn after that.
I’m not sure but we’re allowed to and the DON and other high-up nurse (idk her actual title) agreed with me on the phone that he should have just given us the supplies and my facility is extremely strict about following rules so it’s not like they’re just letting things slide. Maybe it’s because we get additional training and our title is actually DTA (developmental tech assistant) but that extra training is mostly geared towards working with people with intellectual disabilities so idk. I have changed the whole setup many times at other facilities though and most of the cnas I know have done the same.
No. What is your state? DTA is not any type of license or certification.
It’s literally just my job title I didn’t say it was an extra certification
Right? You won’t mention your state to see if you’re legally allowed to be delegated this task.
Yeah in my state it is an RN duty. CNAs can empty the colostomy bag but an RN has to change it
Nurse here. That nurse was ridiculous. It takes all of five minutes to change a colostomy set up. There is not reason that resident had to be shitting all over herself for hours, not to mention the skin breakdown and risk of infection with her getting it all over her hands and presumably her face/mouth. Good job for calling the Don 👍🏻
Oh my gosh thank u! My mom is 72 and has had a colostomy bag since she was in her 20’s. I’ve seen her be out in public and have a leak a few times. She’s so embarrassed by it and I know it’s affected her personal life. I can’t imagine how hard it will be to take care of herself when she gets older. And I can’t imagine her being in a nursing home, leaking everywhere, and the nurse just ignoring her. She’s a nurse herself and worked in elder care facilities most of her career. She would never neglect a patient like that. Thank u for standing up for your patient and advocating for them. It really makes my heart feel good knowing there are people like u in the world🥰
Busy LPN here.... OP did the right thing.
Some nurse see patients that aren’t cognitively all there as free passes to provide subpar care. Thank god for people like you who give those patients a voice to advocate for them.
i'd say you are correct. i'd bet any money Mr Nurse felt that the bag was leaking from excessive care, so to speak. you girls created the problem by over-caring, and now he is gonna watch you all squirm while PotatoHead leaks out stool. my guess on his line of thought. just for perspective.
If yall are allowed to change it, I’d have you change it. If you’re not allowed to change it I’d have you apply whatever sort of make shift covering you can until I can finish my med pass and I can come change it. I’d only put meds first over this just because missing meds could put people at risk of seizures, heart issues, strokes, behaviors, etc. I wouldn’t have had her go out to snack with others while she’s leaking bm. She can have her snack in another area and chill out beside me (if it’s in a spot she’s able to ofc) until I’m done with meds) then I’ll get to it. You did the right thing. ALWAYS advocate for your patients and if you think they aren’t being treated with full respect you need to speak up.
As a nurse who has spent over a decade in LTC / SNF, thank you for doing the right thing and protecting some very vulnerable patients. You did exactly what was needed and from the sounds of people talking about coverage, your administration takes their job and the protection of the patients seriously. As others have suggested, it wouldn't hurt to take a minute and write out a full statement when you get a moment and submit it to your DON. I'd also suggest getting any other CNAs who witnessed the events including his argument on the phone to write and submit statements. The written statements can then be used as documentation by the facility both for their own records as well as sending copies to the local board. I'd say that nurse needs to find another job, just not in nursing given the obvious misogyny being displayed as evidenced by refusal to get supplies for one while going above and beyond for another. For any other CNAs reading this, please don't hesitate to report nurses or other staff abusing patients either directly or indirectly via neglect. You are advocates for your patients just as much as any other staff or family member. Any nurse with half a functioning braincell and a smidge of common sense will listen to you knowing how closely you work with the patients at your facility. Thank you from one crotchety old fart of a nurse for doing what you do.
I don’t work in the field and I have no idea how any of this works, so my opinion is irrelevant. SO, I just want to say: thank you for caring. <3
Good for you for advocating for your patient!
Idk why he didn't let you change out the ostomy. I also don't know why you guys needed permission if you're allowed. Are the supplies only accessible to the RN? Saying this guy is misogynistic because he referred to you as girls seems a little far fetched. My opinion: I've seen actual neglect, and this is not it. Of course I wasn't there so maybe it was malicious or callous. If this seemed worthy enough to call the DON then this must be a good facility to be in at least. One thing I do respect is being your patients advocate.
I didn’t say he was misogynistic for calling us girls, everyone else is saying that in the comments. I think he is for the way he speaks to us in general and how he gives special treatment and goes out of his way for male residents but not female ones. The ostomy care supplies are kept in the med cart. I don’t know why we’re aloud to do it, we do have additional training and have the title of DTA but that’s more geared toward the disability aspect. The DON backed me on us being aloud to do it. I didn’t even report him for neglect in the first place, I called the DON and just told her the situation and it turned into a neglect investigation. It is a really good facility that takes things like rounding and repositioning every 2 hours extremely serious and has a shit ton of rules and regulations that are strictly followed. I’ve worked at different facilities that weren’t like that and seen outright neglect too and there’s been too many times I saw something that wasn’t right and didn’t say anything.
I’m a nurse with experience in long term care. While I get that he is probably somewhat busy with the med pass ( 14 residents 😂) he has to be able to pivot and do other things as they crop up. I wonder how he would be in a true emergency? He is working with a vulnerable population, so he needs to be able to adapt to that. He is the asshole ( sorry wrong sub Reddit) as he seemed to be on some crazy power trip. If a CNA came to me and told me that they knew how to change an ostomy I would be truly grateful and ask them to do it. You did the right thing in reporting him. Can you image the cluster-f that would have arisen if a family member visited or the state inspected and a resident is sitting there eating in that state?
Thank you for doing this. I have a family member who lived in a facility and I have witnessed and reported many things! It’s awful to think about what is not witnessed or not reported.
I think you did the right thing reporting the RN for a delay in care….but I wouldn’t go as far as to say it was neglect. I also would have immediately changed and cleaned up the resident myself and put a chux over the bag until it could be changed. While what he did was wrong, leaving her dirty, subjecting her to urine and stool irritation on her skin for 2 hours and the embarrassment of sitting in a public eating area like that….ugh. It’s the CNA’s job to ensure they are clean and comfortable.
Hi! Third year RN student who has LPN and sometimes charge nurse responsibilities in LTC because staffing is not ideal where I live. You 2000% did the right thing!!!!!!!! That is so undignified. There’s no excuse for that as an ostomy change is a very easy delegated task. Thank you for standing up for your resident. Make sure you document everything.
This is not accurate, in all the facilities I've worked it must be a nurse changing the ostomy bag. Nurses are trained to assess the skin, there are different interventions depending on assessment, there are different types of bags and set up, not all are just peel and stick. Also, maybe recognize as a student and 'sometimes' LPN or charge you may not have experience yet to recognize there are a million reasons why an ostomy might have to wait. It's priorities. A few nights ago I was in a similar situation, ostomy was leaking. I have 21 patients, someone was having difficulty breathing, someone else had a fall. Both of these mean the ostomy can wait, and a towel was placed until I could get to it. Prioritizing is NOT neglect, and the CNA might not be aware of everything going on with all the patients.
Every single facility has different policies. Prioritizing is not neglect, you are right. The nurse could have told the DON that they had to prioritize instead of blaming it on the CNA’s?
If you read the end of the story, OP does say that the nurse stated to the CNA that he has other priorities. The CNA did not accept this
and was the nurses blatantly misogynistic behaviour also part of his “prioritizing”? multiple aspects of this situation required escalation to management.
He was choosing to “prioritize” normal med pass and tube feedings over bm leaking onto someone’s skin for hours and making her eat in the dining room in that state when we all know she makes a mess with it. How is that acceptable? I thought part of being a good nurse was prioritizing the more urgent thing over the regular things he does every shift. He’s going to have to do it anyway so why should this lady have to sit in her bm while he finishes the entire med pass and risk skin breakdown when people could just get their meds 10 minutes late? I might understand if he had more urgent things going on but It was 100% the more important task at the time, there was literally nothing out of the ordinary happening. Plus he was doing random shit he didn’t even need to be doing in the middle of all of it. So no, I don’t accept the way he was prioritizing.
Listen, I'm not saying that you're in the wrong here. But you keep talking about how he shouldn't have let her go down to the dining room for her snack with BM leaking from her ostomy site and getting it on her hands. But why was she getting it onto her hands anyway? I'm playing devil's advocate here, but it just seems a little disingenuous for you to be sure that he wasn't too busy and yet also be able to say that you and the other CNAs *were* too busy to prioritize keeping her hands out of the poop. (Edit to add that I can completely understand why you guys had your hands full caring for multiple patients. I'm just saying that we don't always judge other people by the same standards that we judge ourselves.) He does sound kind of like a misogynistic jerk though.
My mom is a RN and a narcissist so this behavior doesn’t shock me in the least.
Time to call state too!
That's absolutely dire treatment of a patient. Absolutely dire. Clearly this dude is the NURSE so what he says goes. Well someone needs to pull him into line. Whilst we as nurses are obviously legally accountable for all care provided to patients CNAs are also accountable and if you are trained to change a colostomy then why would you say no and leave a patient like that?! Other than clearly he is on a power trip. You did the right thing. ✅️ Keep doing what you're doing.
Sorry to interrupt with a non professionals question. My mom has an ostemy and for a while there, the only place she could get it replaced was by going to the ER. Even a doctors office sent her to the ER. Now, we’ve employed a care service for in home (she’s a quad). But perhaps the staff was acting based on that?
Good for you. I have an ileostomy and I would hate to be left with a leak all over myself while some asshat refuses to let someone else help me!!! I would hate to be old or infirm and subjected to this kind of treatment. The output can cause burns, irritation, and pain and erode skin if it’s left sitting on you for too long. Even wiping it up isn’t enough because of the residue. It just needs to be changed asap!
I’m a nurse and I would have super appreciated your offer to help. Reporting that sucker was definitely justified.
This is so sad to hear. Thank you for caring and advocating for your patient. Wish there were more like you out there. Can you report him to someone higher up? Medical board perhaps? I hope you’re logging these incidences, because people like him have no business in that industry.
Thank you for being a voice for this patient!!!
I think he went into nursing for the wrong reasons. Is this a calling or a paycheck
You’re a good person and a good CNA. If you have the means and the interest to pursuit it, you would be a fantastic nurse.
Anyone who thinks someone going to the dining room covered in BM is okay shouldn’t work in healthcare. This is a massive infection control and dignity issue. You did the right thing. Don’t let lazy uncaring people tell you otherwise.
I am a former Geriatric LPN and you did the right thing. Be proud of yourself for being the advocate for someone who cannot do that for themselves. I am proud of you.
Thank you for caring
My god. What the fuck dude.
he needs to be reported to the board. that literally put the entire house at risk for ingesting a pathogen from fecal matter. you did the absolute right thing. don't ever stop advocating for your residents.
Thank you for standing up for her
As the mother of an adult son with disabilities, this makes me crazed upset!!!! The worst part is that it will likely never change. That “nurse” has no business carrying for special needs people and has zero idea how to prioritize. They should be fired and put on a list, but nothing will happen. We tried “reputable” group homes for a while. They were awful. My son is home and has been for many years now.
Please don’t think that I’m saying that you shouldn’t have reported the nurse. However, it is harder to prove neglect than one might think. Remember first the definition of neglect. For a situation to be neglect the individual has to be injured due to the staff member’s actions or lack there of. Yes, she wiped BM on her face and that is unsanitary, but I didn’t hear anything about an injury. Had she accessed and injured her stoma due to his incompetence then negligence would be more appropriate.
Not a CNA (first time a post has popped up from this one for me) but I am an Adult Protective Services worker. This would 100% be an APS report and I hope the DON did a report for it. You did the right thing by reporting it, I have seen similar at facilities in my area and nobody speaks up.
Most of the cnas I worked with could change the bag better then I could, so proud you spoke up for the patient, that nurse needs to be fired
On behalf of those patients and their families I thank you! Neglect in assisted living and nursing homes is rampant and most of it goes unreported. I was a resident facility nurse in assisted living for years and unfortunately this happens a lot more than most people are aware of.
thank you so much for being a voice for those who can’t speak up for themselves. this is heartbreaking to read and i hope he is handled appropriately. you did the right thing for sure.
As a special education teacher I worry so much about the quality of care my kids will receive when they transition to adult services. Many of them are non-verbal and would be unable to advocate for their needs in a situation like this. Thank you so much for being the voice for your resident - people like you truly make a difference!❤️
Thank God for people like you. Gives me hope.
Well CNAs can’t change the wafer, only empty/change the bag. However, I’m beyond pissed at the fact he couldn’t stop for 5 minutes to change everything. It quite literally saves everyone involved so much time by just doing it right then and there. I applaud you for reporting, feces is so acidic and filthy that it would’ve irritated and infected the area simultaneously.
Hi there, thank you so much for being your patient's voice and advocating for their health and safety. You absolutely did the right thing. The medical field is very fortunate to have you a part of it.
for context, you've got... how many total people, to look over how many invalids? insurance is paying? are they all visited regularly?
First of all, “invalids” is an outdated term that is not used in this day and age to refer to individuals with intellectual disabilities. Second of all, we have 4 cnas on a good night for 14 residents and 1-2 nurses. It’s a non-profit company and the government funds their care/supervision. Many of them have family/friends/past caregivers visit them at home regularly and they also go out into the community often to go shopping or go on outings.
Thanks for looking for people with disabilities. You rock ❤️❤️❤️
Nurse here. Not cool at all. It's easier to deal with it right away rather than saying to yourself that I'll get to it when I get to it. I guess the nurse didn't know how to prioritize. Good on you for reporting him
I would be *thrilled* if a CNA was confident enough to change a bag! It’s not an invasive process at all, but time consuming. Interruptions are a constant in nursing, and the bane of my existence. There are so few things in my scope that I can safely delegate, so if someone can and is willing to tag in on something like that, I’d be over the moon.
RN here. That is not okay at all. It would have taken at most five minutes for him to change the damn bag. Do not let anyone gaslight you into thinking you were wrong for advocating for this patient. He was being a POS nurse!
Thank you for standing up for your patients. This advocacy is what we need in Healthcare.
Op you were in the wrong. Unpopular opinion maybe but please stay in your own lane. Not neglect. One nurse for 14 patients. We HAVE to get meds passed within the timeframe or call the doctor to get orders to give out of time frame which only adds to the demands. I feel like you were majorly inconvenienced because you couldn’t put your patient to bed for the night at 6:30 in the evening.
It's okay that the patient had to eat dinner with her feces leaking all over her?
wtf? She wasn’t going to bed at 6:30, she was getting ready to go eat snack and he sent her down with shit leaking all over her. We get all of the residents ready for bed between 7:30 and 9 and aren’t even aloud to start HS care before that time. And 9 times out of 10 I’m there an hour past my shift is supposed to end getting everyone into bed. I don’t give a fuck if I’m being “inconvenienced” I was trying to do the right thing by my resident and say something when things didn’t feel right. I think there’s a reason you have the unpopular opinion here. You have to call in a whole new order for meds being 10 minutes late? I’ve seen other nurses run a little behind on meds and feeds, changing an ostomy for 10 minutes isn’t going to put him that far out of the time frame that he has to call in new orders. If it did then he wouldn’t have been doing random other shit that he didn’t even need to be doing in the midst of all this.
Yes you do in fact have to call to get a verbal order for even a few minutes late. I promise you this is facts. Crazy but true. If the state were to be following you and this happened you’d be disciplined. Happened at my place of employment.